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Motor Skills
Motor skills or coordination is the product of a complex set of cognitive and physical processes. Smooth, targeted, and accurate movements, both gross and fine, require the harmonious functioning of sensory input, central processing of the information in the brain and coordination with the high executive cerebral functions, such as volition, motivation, motor planning of an activity. The performance of a certain motor pattern is also important. All of these elements must work in a coordinated and rapid way to enable complex movements involving different parts of the body.

Motor Skill

Gross motor skills

Includes lifting one's head, rolling over, sitting up, balancing, crawling, and walking. Gross motor development usually follows a pattern. Generally large muscles develop before smaller ones, thus, gross motor development is the foundation for developing skills in other areas like fine motor skills. Development generally moves from the top of the body down to the bottom.

Fine motor skills

Includes the ability to manipulate small objects, transfer objects from hand to hand, and various hand-eye coordination tasks. Fine motor skills may involve the use of very precise motor movement in order to achieve an especially delicate task. Some examples of fine motor skills are using the pincer grasp using the thumb and forefinger to pick up small objects, cutting, coloring, or writing. Fine motor development refers to the development of skills involving the smaller muscle groups.

Ambidexterity

Is a specialized skill in which there is no dominance between body symmetries, so tasks requiring fine motor skills can be performed with the left or right extremities. The most common example of ambidexterity is the ability to write with the left or right hand, rather than one dominant side.

Motor skill dysfunction has many causes, such as the demyelination of motor neurons. While fatigue or weariness may lead to temporary short-term deterioration of fine motor skills observed as visible shaking, serious nervous disorders may result in a loss of both gross and fine motor skills due to the hampering of muscular control.
Motor Symptoms
Motor symptoms have to deal with the muscular movement of any part of the body. This movement refers to something that produces or refers to motion. An example being a motor neuron is a nerve cell that conveys an impulse to a muscle causing it to contract. Multiple sclerosis (MS) motor symptoms typically involve weakness, leg dragging, stiffness, a tendency to drop things, a feeling of heaviness, clumsiness, or a lack of coordination. It's associated with muscle tightness and weakness that limit a limb's range of movements.

Muscle-related symptoms most often occur in the arms and legs and at times, these symptoms may impair walking. Spasticity, which is the involuntary tightening of a muscle, can manifest as stiffness, pain or spasms. Some may experience an intention tremor causing difficulty in making small or complex movements and notice their hands shake when trying to pick something up, write, or button their shirt.

Muscle-Related Symptoms may include:
Loss of balance
Numbness or abnormal sensation in any area
Pain because of muscle spasms
Pain in the arms or legs
Problems moving arms or legs
Problems walking
Problems with coordination and making small movements
Slurred or difficult-to-understand speech
Tremor in one or more arms or legs
Uncontrollable spasm of muscle groups (muscle spasticity)
Weakness in one or more arms or legs
Loss of Mobility and Spasticity
Spasticity is a condition in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and may interfere with movement, speech, and manner of walking. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement.

Symptoms may include hypertonicity (increased muscle tone), clonus (a series of rapid muscle contractions), exaggerated deep tendon reflexes, muscle spasms, scissoring (involuntary crossing of the legs), and fixed joints. The degree of spasticity varies from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms. Spasticity can interfere with rehabilitation in patients with certain disorders, and often interferes with daily activities.

Almost everyone with MS will have some loss of mobility, which may take the form of impaired (lessened) motor control, muscle weakness, impaired balance, and spasticity. Spasticity is one of the primary symptoms of MS and is characterized by weakness, loss of dexterity, and the inability to control specific movements. It's usually more severe in the legs and torso. Mobility can also be affected by many non-physical factors including mental well-being, social networks, fatigue, and even the weather.

In the case of MS, spasticity is due to nerve conduction being interrupted by a lesion located in the brain or spinal cord. It can be present at any point of the disease (early or late onset) and the symptoms can vary from mild to severe. In severe cases, spasticity can even cause a limb to become "frozen" in a bent position, requiring immediate medical attention.

Spasticity can be complicated by dystonia where the problem is not only increased muscle tone but odd postures such as neck twisting to one side or the other. Dystonia can also exist alone as an isolated movement disorder in MS. One or more muscles or muscle groups can be involved in spasticity or dystonia. Muscle spasticity, or excessive tightness, is common and may be more disabling than weakness.

Spasticity occurs as a result of an imbalance between the excitatory and inhibitory signals from the brain and/or spinal cord. Excitatory signals send messages to other neurons, firing them into action, whereas inhibitory signals stop neurons firing and suppress a response, such as stopping a full bladder from spontaneously emptying itself. It's thought that there is an interruption of the inhibitory signals along the spinal cord and in the brain which results in an increased excitation and therefore an imbalance.

Spasticity affects body functions and can cause activity limitations and participation restrictions, primarily due to its effect on functional movement.

Detrimental Consequences Associated with Spasticity:
Interference with mobility, ability to exercise and the range of motion in joints
Negative impact on endurance and energy expenditure
Interference with the activities of daily living
Discomfort or pain
Sleep disturbance

Those who have severe pain or spasticity may benefit from having a catheter or pump placed in the lower spinal area to deliver a constant flow of medication, such as baclofen if oral medications fail.

It's important to approach spasticity management from an interdisciplinary team approach with everyone involved so they can better identify goals and make the adjustments necessary to attain optimal spasticity management. Goals of spasticity management should be orientated towards the improvement of function and improved comfort, and an individual's response to interventions such as medications, rehabilitation or surgery needs to be closely monitored.

Positioning

It's important that the person with spasticity is positioned correctly when sitting and lying down to prevent limbs becoming fixed in an inappropriate position. They should be able to lie flat every day in order to stretch the muscles involved. Lying on the side and standing are also useful for stretching muscles in spasm. Posture when sitting needs to be well balanced and stable. Special seating systems are available to help with this. The person should be moved regularly to avoid damage to skin and help in joint mobility. Design of the wheelchair is also important, as it's essential that it provides support for the upper body and limbs.

A Surgical Option For Tremors

Those with MS who have severe spasticity or muscle stiffness may be helped by the insertion of a spinal pump (drug catheter or pump) to deliver medicines when oral medicines fail. This treatment is only considered after other options have failed. Those individuals may benefit from having a catheter or pump placed in the lower spinal area to deliver a constant flow of medicine, such as baclofen.